NPIMap

Organization Active NPI

Positive Impact Health Centers Inc

  • Primary Care Clinic/Center
  • Duluth, GA
National Provider Identifier
1790861995
Registry record updated Jan 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
024478 Issued in GA
Legal business name
POSITIVE IMPACT HEALTH CENTERS INC
Practice address
3350 Breckinridge Blvd Ste 200
Duluth, GA 30096
Phone
(770) 962-8396
Fax
(770) 962-1291
NPI assigned
Oct 31, 2006
Last updated
Jan 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Barbara Nkomazana
Title
Billing Specialist
Phone
(404) 589-9040

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU
Primary Care Clinic/Center 261QP2300X 024478 GA Primary

Addresses

Primary practice location

3350 Breckinridge Blvd Ste 200
Duluth, GA 30096

Mailing address

3350 Breckinridge Blvd Ste 200
Duluth, GA 30096-4959
Phone (770) 962-8396

Other practice location 1

1650 County Services Pkwy SW
Marietta, GA 30008-4010
Phone (770) 514-2464

Other practice location 2

523 Church St
Decatur, GA 30030-2515
Phone (404) 589-9040

Other identifiers 2

IdentifierTypeStateIssuer
000675342AMedicaidGA
536210665AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040907000653 GA Part B Supplier - Clinic/Group Practice 5496721987 Receives reassigned benefits from 38 practitioners
Practice locations: Decatur, GA; Duluth, GA; Jonesboro, GA; Marietta, GA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2169627Positive Impact Health Centers, Inc1650 County Services Road, Marietta, GA 30008Certificate of waiverJul 23, 2027

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/6123adb2-d0d2-485a-9dcf-5fba87efb2ef/

Practitioners & affiliated clinicians

Practitioners 43

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 43

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704240000000",
    "number": "1790861995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3350 BRECKINRIDGE BLVD STE 200",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300964959",
            "telephone_number": "770-962-8396",
            "fax_number": "770-962-1291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3350 BRECKINRIDGE BLVD STE 200",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "30096",
            "telephone_number": "770-962-8396",
            "fax_number": "770-962-1291"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1650 County Services Pkwy SW",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "GA",
            "postal_code": "300084010",
            "country_code": "US",
            "telephone_number": "770-514-2464",
            "fax_number": "770-514-2806",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "523 Church St",
            "address_purpose": "LOCATION",
            "city": "Decatur",
            "state": "GA",
            "postal_code": "300302515",
            "country_code": "US",
            "telephone_number": "404-589-9040",
            "fax_number": "404-589-1615",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "POSITIVE IMPACT HEALTH CENTERS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-31",
        "last_updated": "2024-01-03",
        "certification_date": "2023-08-24",
        "status": "A",
        "authorized_official_last_name": "NKOMAZANA",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_title_or_position": "BILLING SPECIALIST",
        "authorized_official_telephone_number": "404-589-9040"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "024478",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000675342A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "536210665A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.